School of Psychiatry,University of New South Wales,Sydney,NSW,Australia.
Int Psychogeriatr. 2015 Oct;27(10):1601-11. doi: 10.1017/S1041610215000629. Epub 2015 Apr 16.
Concerns about suicide risk in people with dementia have been increasing in recent years along with a discourse about rational suicide and assisted suicide.
A systematic narrative literature review of suicidal behavior and assisted suicide in persons with dementia.
Most studies that have examined the spectrum of suicidal ideation, attempted suicide and suicide in dementia have methodological limitations but the overall suicide risk does not appear to be increased. When suicidal behavior does occur, common themes include the presence of psychiatric comorbidity, mainly depression; occurrence early in the dementia course with preserved insight and capacity; and an increased risk in younger people. The emerging discourse on rational and assisted suicide has been spurred by early and pre-symptomatic diagnosis and poses a number of ethical challenges for clinicians including the role of proxy decision-makers.
Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.
近年来，人们对痴呆患者自杀风险的担忧与关于理性自杀和协助自杀的讨论一起不断增加。
对痴呆患者自杀行为和协助自杀进行系统的叙事文献综述。
大多数研究检查了痴呆患者自杀意念、自杀未遂和自杀的范围，但这些研究都存在方法学上的局限性，但总体自杀风险似乎并未增加。当自杀行为确实发生时，常见的主题包括存在精神共病，主要是抑郁症；在痴呆症病程早期出现，洞察力和能力保持完好；以及在年轻人中风险增加。关于理性和协助自杀的新兴论述是由早期和症状前诊断引发的，这给临床医生带来了一些伦理挑战，包括代理人决策者的角色。
尽管痴呆症可能不会导致自杀行为的整体风险显著增加，但临床医生仍需要特别在痴呆症病程早期考虑到脆弱个体的自杀可能性。
